07/12/2022
By Maureen Martin

The Zuckerberg College of Health Sciences, Solomont School of Nursing, invites you to attend a doctoral dissertation defense by Nadia Raymond on " Exploring Moral Injury Among Intensive Care Unit Nurses Working the Frontlines During the COVID-19 Pandemic: A Qualitative Study."

Date: Wednesday, July 27, 2022
Time: 10 a.m. to noon
Location: This will be a virtual defense via Zoom. Those interested in attending should email Nadia_Raymond@student.uml.edu and committee chair Ainat_Koren@uml.edu at least 24 hours prior to the defense to request access to the meeting.

Committee Chair: Ainat Koren, Ph.D., DNP, PMHNP, Ph.D. Program Director and Associate Professor, Solomont School of Nursing, University of Massachusetts, Lowell

Committee Members:

  • Annie Lewis O'Connor, Ph.D, NP-BC, MPH, FAAN, Brigham and Women's Hospital
  • Lisa Sundean, Ph.D., MHA, RN, Associate Professor, University of Massachusetts, Boston

Abstract:

Background: Understanding factors contributing to Moral Injury (MI) among Intensive Care Nurses (ICU) working on the frontlines of the COVID-19 pandemic may inform education, intervention, and research contributing to nurses' wellbeing and mental health. The toll on our nurses will be much more significant than many realize, with one in five health care workers have left their jobs and 2/3 of intensive care unit (ICU) nurses quitting or transitioning to new specialties. The trauma of these experiences can lead to moral injury, an emerging phenomenon recognized as a possible source of traumatic sequelae for nurses.

Aim: The primary aim of this study was to analyze the lived experiences of intensive care nurses delivering care on the frontlines of the COVID-19 pandemic using a trauma-informed lens and specifically exploring factors related to moral injury caused by the pandemic amongst ICU nurses. The study was conducted during the COVID-19 pandemic and provided initial insight into the concept of moral injury and its impact on ICU nurses' wellbeing.

Method: The Trauma-Informed Care (TIC) conceptual framework is a multifaceted model adapted to guide the qualitative descriptive study and open-ended response thematic analysis at the intrapersonal, interpersonal, and collective levels. The interview questions were comprised of The Substance Abuse and Mental Health Services’ (SAMHSA) six principles that guide a trauma-informed approach, including Safety, Trustworthiness, Peer support, Collaboration Empowerment & Cultural, historical & gender issues.

Findings: Interviews were conducted with 14 (n=14) ICU nurses caring for COVID-19 patients in various ICUs during the pandemic. Most of the participants were female (n=12), with two male participants (n=2); eleven participants identified as White (n=11). Participants' ICU experience ranged from one year to 11 years or longer. Thematic analysis and NVivo version 12 were used to analyze the data. Six themes emerged from the data analysis: the call of a nurse, humanity stripped from practice, pervasive isolation, high acuity, sadness, powerless, and holding each other up.

Conclusion: ICU nurses have experienced profound losses in their personal, interpersonal, and collective milieu, and understanding the impact of the COVID-19 pandemic on nurses' mental health and wellbeing from a nursing perspective is critical to best inform strategies toward health promotion and healing for all nurses. Trauma-informed care (TIC) is based on a framework that recognizes people's lived experiences and expands across more areas in health care institutions. The researcher's unpublished concept analysis on moral injury in nursing in the context of COVID-19 provided foundational information to guide the development of future interventions. Moreover, as the pandemic recedes, the qualitative study's findings will further inform and guide education, prevention, and nursing research, contributing proactively to reducing the adverse effects of moral injury. More profound research is needed to explore moral injury in nursing further and inform peer-to-peer support programs at an institutional level.

Key terms: COVID-19, Coronavirus, ICU nursing, moral injury, trauma-informed approach.